Objective:To design a special device for limiting position of boat-shape headrest of breast brackets,and explore its application value in radiotherapy post-radical mastectomy.Methods:1 cm plex glass plate was cut as T-shape base plate,and the top of the T-shape base plate was drilled to obtain four holes for limiting position.A 2 mm acrylic plate was cut as horse hoof-shape and strip-shape pieces for limiting position,which were adhered respectively to the top and bottom of the T-shape base plate to form a boat-shape headrest with groove structure for limiting position.Self-made pillars with limiting position were used to connect the T-shape base plate with the backplane of breast bracket,so as to realize rigid connection between conventional boat-shape headrest and breast bracket.A total of 60 female patients who received radiotherapy after radical mastectomy for breast cancer at Changzhou Cancer Hospital during January and December 2023 were selected.They were randomly divided into an observation group and a control group(with 30 cases in each group)by using a random number table.The observation group adopted breast bracket combined with self-made boat-shape headrest for limiting position device+boat-shape headrest to conduct fixation,while the control group adopted rotundity headrest of breast bracket to conduct fixation.Both groups adopted hybrid intensity-modulated radiotherapy(IMRT)technique to formulate plan,and the exposure dose was 50Gy/25 fractions,and patients received radiotherapy as 5 times per week,and the treatment course was 5 weeks.Cone-beam computed tomography(CBCT)was used to conduct verification for position before the first 3 treatments.During the treatment duration between the 2nd and the 5th week,CBCT verification for position was conducted in each week.The positioning error and positioning time on left-right direction(x),head-foot direction(y)and abdomen-back direction(z)at each time between two groups were compared.Results:The positioning errors on x,y,z direction of three dimension at each time in observation group were lower than those in control group,and the differences were significant(Z=-7.666,-11,672,-6.311,P<0.05).The average positioning time at first time and the total average positioning time were respectively(222.4±12.9)s and(212.2±15.1)s in observation group,all of which were lower than(262.9±12.5)s and(254.0±15.7)s in control group,and the differences were significant(t=12.364,27.783,P<0.05).Conclusion:The combination of breast bracket and self-made device with boat-shape for limiting position can increase precision and efficiency of positioning,and improve comfort through individually chooses the type of boat-shape headrest,and set the position of headrest,which has favorable clinically application value.

Objective The differences in biomechanical characteristics of the lower limbs between individuals with chronic ankle instability(CAI)and healthy individuals during unanticipated and anticipated jumping were compared,in order to provide practical references and ideas for the prevention and treatment of recurrent ankle sprains.Methods Thirty subjects were recruited,including 15 patients with CAI and 15 healthy volunteers.All subjects completed unanticipated and anticipated jumping tests in a random order,with a 1-week interval between the two tests.Kinematic and kinetic data of lower limbs were collected synchronously using Vicon infrared high-speed motion capture system and Kistler three-dimensional force platform.Results At the moment of touchdown,knee flexion angle was significantly greater during unanticipated jumping than that during anticipated jumping(P=0.009),while ankle eversion angle was notably lower(P=0.043).During the early landing phase,unanticipated jumping showed significantly greater peak hip flexion and abduction angles,as well as knee flexion(P=0.038,P=0.036,P=0.04),while peak ankle dorsiflexion and eversion angles were significantly lower(P=0.001,P=0.01)compared to anticipated jumping.Additionally,peak hip abduction moment during unanticipated jumping was significantly higher in patients with CAI than that during anticipated jumping(P=0.028).Conclusions Unanticipated jumping reduced ankle dorsiflexion and eversion angles in individuals with CAI,putting the ankle in an open,sprain-prone position.Individuals with CAI compensated proximally by increasing hip flexion,abduction,knee flexion angles,and hip extension moment to stabilize the ankle.

Purpose To evaluate the value of tumors invasion in the central airway(TICA)in predicting the severe immune checkpoint inhibitor-related pneumonitis(S-CIP)in lung cancer patients using propensity score matching(PSM).Materials and Methods The intact data of 162 consecutive lung cancer patients who received treatment with immune checkpoint inhibitors in Xi'an International Medical Center Hospital from September 2019 to March 2022 were retrospectively collected.Patients were divided into S-CIP group(23 cases)and non-S-CIP group(139 cases)according to the presence of S-CIP.The demographic information of the patients,including gender,age,history of smoking,thoracic radiotherapy histology,baseline lung diseases,classification,TNM stage,tumor location as well as TICA were collected.A binary Logistic regression was used to analyze the confounding factors and independent risk factors of S-CIP and to predict the development of S-CIP.A 1:1 matching was performed by the nearest neighbor method for PSM.The PSM was used to pair the two groups,and the value of TICA in predicting S-CIP before and after PSM was compared.The receiver operating characteristic curve and the area under the curve were used for model performance based on TICA.Results Before PSM,the proportion of baseline lung diseases(78.3%vs.32.4%,OR=6.802,P=0.001),thoracic radiotherapy history(69.6%vs.30.2%,OR=5.300,P=0.002)and TICA(65.2%vs.27.3%,OR=5.882,P=0.001)in the S-CIP group was higher than those in the non-S-CIP group,and were independent risk factor for predicting S-CIP.After PSM,20 patients were included in each group.The presence of TICA was higher in S-CIP group than that in the non-S-CIP group(60.0%vs.20.0%,OR=6.000,P=0.013).The area under the curves of Logistic regression model based on TICA was 0.700(95%CI 0.534-0.866).Conclusion TICA is an independent risk factor for development of S-CIP,which has moderate degree of accuracy in predicting S-CIP,can be used for risk prediction and early intervention to reduce the poor prognosis of S-CIP patients.

The reform of high-value medical consumables governance is a key component of China's healthcare system reform,aiming to reduce patients'financial burden,standardize clinical practices,and promote high-quality development of public hospitals.Although notable progress has been made through centralized volume-based procurement and usage supervision of high-value medical consumble,there are still several challenges remain,including distorted enterprise behavior,misalignment between procurement and clinical needs,increased hospital operating pressure,and insufficient coordination between health and insurance policies.To achieve the governance goal,implementing the policy design and enhancing the department integration are suggested.It is needed to deeply establish multi-stakeholder coordination mechanisms,promote the integration of medical services,medical insurance,and pharmaceuticals("three-medicine linkage"),optimize procurement rules,strengthen supervision of consumable use,improve the quality evaluation system,promote hospital management,and develop emergency mechanisms for consumables shortages.

The reform of high-value medical consumables governance is a key component of China's healthcare system reform,aiming to reduce patients'financial burden,standardize clinical practices,and promote high-quality development of public hospitals.Although notable progress has been made through centralized volume-based procurement and usage supervision of high-value medical consumble,there are still several challenges remain,including distorted enterprise behavior,misalignment between procurement and clinical needs,increased hospital operating pressure,and insufficient coordination between health and insurance policies.To achieve the governance goal,implementing the policy design and enhancing the department integration are suggested.It is needed to deeply establish multi-stakeholder coordination mechanisms,promote the integration of medical services,medical insurance,and pharmaceuticals("three-medicine linkage"),optimize procurement rules,strengthen supervision of consumable use,improve the quality evaluation system,promote hospital management,and develop emergency mechanisms for consumables shortages.

Objective The differences in biomechanical characteristics of the lower limbs between individuals with chronic ankle instability(CAI)and healthy individuals during unanticipated and anticipated jumping were compared,in order to provide practical references and ideas for the prevention and treatment of recurrent ankle sprains.Methods Thirty subjects were recruited,including 15 patients with CAI and 15 healthy volunteers.All subjects completed unanticipated and anticipated jumping tests in a random order,with a 1-week interval between the two tests.Kinematic and kinetic data of lower limbs were collected synchronously using Vicon infrared high-speed motion capture system and Kistler three-dimensional force platform.Results At the moment of touchdown,knee flexion angle was significantly greater during unanticipated jumping than that during anticipated jumping(P=0.009),while ankle eversion angle was notably lower(P=0.043).During the early landing phase,unanticipated jumping showed significantly greater peak hip flexion and abduction angles,as well as knee flexion(P=0.038,P=0.036,P=0.04),while peak ankle dorsiflexion and eversion angles were significantly lower(P=0.001,P=0.01)compared to anticipated jumping.Additionally,peak hip abduction moment during unanticipated jumping was significantly higher in patients with CAI than that during anticipated jumping(P=0.028).Conclusions Unanticipated jumping reduced ankle dorsiflexion and eversion angles in individuals with CAI,putting the ankle in an open,sprain-prone position.Individuals with CAI compensated proximally by increasing hip flexion,abduction,knee flexion angles,and hip extension moment to stabilize the ankle.

Purpose To evaluate the value of tumors invasion in the central airway(TICA)in predicting the severe immune checkpoint inhibitor-related pneumonitis(S-CIP)in lung cancer patients using propensity score matching(PSM).Materials and Methods The intact data of 162 consecutive lung cancer patients who received treatment with immune checkpoint inhibitors in Xi'an International Medical Center Hospital from September 2019 to March 2022 were retrospectively collected.Patients were divided into S-CIP group(23 cases)and non-S-CIP group(139 cases)according to the presence of S-CIP.The demographic information of the patients,including gender,age,history of smoking,thoracic radiotherapy histology,baseline lung diseases,classification,TNM stage,tumor location as well as TICA were collected.A binary Logistic regression was used to analyze the confounding factors and independent risk factors of S-CIP and to predict the development of S-CIP.A 1:1 matching was performed by the nearest neighbor method for PSM.The PSM was used to pair the two groups,and the value of TICA in predicting S-CIP before and after PSM was compared.The receiver operating characteristic curve and the area under the curve were used for model performance based on TICA.Results Before PSM,the proportion of baseline lung diseases(78.3%vs.32.4%,OR=6.802,P=0.001),thoracic radiotherapy history(69.6%vs.30.2%,OR=5.300,P=0.002)and TICA(65.2%vs.27.3%,OR=5.882,P=0.001)in the S-CIP group was higher than those in the non-S-CIP group,and were independent risk factor for predicting S-CIP.After PSM,20 patients were included in each group.The presence of TICA was higher in S-CIP group than that in the non-S-CIP group(60.0%vs.20.0%,OR=6.000,P=0.013).The area under the curves of Logistic regression model based on TICA was 0.700(95%CI 0.534-0.866).Conclusion TICA is an independent risk factor for development of S-CIP,which has moderate degree of accuracy in predicting S-CIP,can be used for risk prediction and early intervention to reduce the poor prognosis of S-CIP patients.

Objective:To design a special device for limiting position of boat-shape headrest of breast brackets,and explore its application value in radiotherapy post-radical mastectomy.Methods:1 cm plex glass plate was cut as T-shape base plate,and the top of the T-shape base plate was drilled to obtain four holes for limiting position.A 2 mm acrylic plate was cut as horse hoof-shape and strip-shape pieces for limiting position,which were adhered respectively to the top and bottom of the T-shape base plate to form a boat-shape headrest with groove structure for limiting position.Self-made pillars with limiting position were used to connect the T-shape base plate with the backplane of breast bracket,so as to realize rigid connection between conventional boat-shape headrest and breast bracket.A total of 60 female patients who received radiotherapy after radical mastectomy for breast cancer at Changzhou Cancer Hospital during January and December 2023 were selected.They were randomly divided into an observation group and a control group(with 30 cases in each group)by using a random number table.The observation group adopted breast bracket combined with self-made boat-shape headrest for limiting position device+boat-shape headrest to conduct fixation,while the control group adopted rotundity headrest of breast bracket to conduct fixation.Both groups adopted hybrid intensity-modulated radiotherapy(IMRT)technique to formulate plan,and the exposure dose was 50Gy/25 fractions,and patients received radiotherapy as 5 times per week,and the treatment course was 5 weeks.Cone-beam computed tomography(CBCT)was used to conduct verification for position before the first 3 treatments.During the treatment duration between the 2nd and the 5th week,CBCT verification for position was conducted in each week.The positioning error and positioning time on left-right direction(x),head-foot direction(y)and abdomen-back direction(z)at each time between two groups were compared.Results:The positioning errors on x,y,z direction of three dimension at each time in observation group were lower than those in control group,and the differences were significant(Z=-7.666,-11,672,-6.311,P<0.05).The average positioning time at first time and the total average positioning time were respectively(222.4±12.9)s and(212.2±15.1)s in observation group,all of which were lower than(262.9±12.5)s and(254.0±15.7)s in control group,and the differences were significant(t=12.364,27.783,P<0.05).Conclusion:The combination of breast bracket and self-made device with boat-shape for limiting position can increase precision and efficiency of positioning,and improve comfort through individually chooses the type of boat-shape headrest,and set the position of headrest,which has favorable clinically application value.

Purpose To observe the clinical and CT features of severe immune checkpoint inhibitor-related pneumonitis(CIP)in lung cancer patients.Materials and Methods A total of 174 patients with lung cancer who received immune checkpoint inhibitor(PD-1/PD-L1 inhibitors)in Xi'an International Medical Center Hospital from September 1,2019 to March 31,2022 were retrospectively collected.Clinical and imaging features of patients with severe CIP were analyzed.Results There were 23 patients who met the diagnostic criteria of severe CIP.Among them,22 were male patients,15 were younger(＜65 years old),17 had a history of underlying lung disease,16 had a history of chemoradiotherapy and other treatments,and 21 had a history of combined radiotherapy and chemoradiotherapy.The median time from the initiation of immune checkpoint inhibitor to CIP was 128(74,348)days.19 patients were non-small cell carcinoma.CIP occurred in 16 patients with right lung cancer,15 had tumor central airway invasion,14 had radiographic features of diffuse alveolar injury/acute interstitial pneumonia pattern,and 20 died during follow-up.Conclusion Severe CIP is likely to occur in male lung cancer patients with a history of basic medical history and radiotherapy and chemotherapy.The clinical manifestations are varied,and the main imaging features are diffuse alveolar injury/acute interstitial pneumonia pattern,and the prognosis is poor.

Objective To construct a diagnostic model for the phlegm-dampness obstruction syndrome in patients with coronary heart disease stable angina pectoris(CSAP);To provide a reference for clinical syndrome differentiation.Methods Totally 305 patients'clinical data were collected from the Department of Cardiology,Dongying Hospital Affiliated to Shandong University of Traditional Chinese Medicine,from May 2022 to January 2024.The least absolute shrinkage and selection operator(LASSO)was used to select features,and multiple models were constructed and compared using machine learning(ML)algorithms.The optimal ML model was selected for training,validation,and testing.Finally,the operational logic of the optimal model was explained using Shapley Additive Explanations(SHAP),and two typical examples were provided to help users understand the model's operational logic.Results LASSO regression identified chest pain,body mass index(BMI),limb heaviness,drinking history,age,triglycerides(TG),total cholesterol(TC),and low-density lipoprotein cholesterol(LDL-C)as features included in the model.After comparing multiple models,the Gaussian Naive Bayes(GNB)model demonstrated the best performance.The final constructed GNB model achieved an average AUC of 0.938(95%CI:0.903-0.972)in the training set,an average AUC of 0.927(95%CI:0.851-0.992)in the validation set,and an AUC of 0.856(95%CI:0.751-0.961)in the test set.The learning curve showed that the error between the training and validation sets in the model converged as the number of training samples increased.The calibration curve showed that the model had good consistency in predicting the probability of observed phlegm-dampness obstruction syndrome patients.The clinical decision curve(DCA)showed that the model could provide clinical benefits for patients at a decision threshold below 0.7.The features ranked by SHAP importance in order were chest pain,BMI,LDL-C,TG,limb heaviness,TC,drinking history and age.Conclusion The diagnostic model for CSAP phlegm-dampness obstruction syndrome constructed in this study can assist physicians in the syndrome differentiation of patients,thereby enabling the formulation of integrated clinical treatment plans combining traditional Chinese and Western medicine,and aiding patients in achieving better clinical therapeutic outcomes.